The supportive therapies (e.g. antiemetics, premedications, etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

The supportive therapies (e.g. antiemetics, premedications, etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

No antiemetics should be routinely administered before treatment in patients without a history of nausea and vomiting. If patients experience nausea and/or vomiting, consider using the low antiemetic prophylaxis regimen.

Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient’s situation including but not limited to treatment intent (curative vs palliative), the antineoplastic regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient​ preferences. Suggested dose modifications are based on clinical trial findings, product information and reference committee consensus. Renal and hepatic dose modifications have been standardised where possible. For more information see dosing considerations & disclaimer.

Discharge information

Exemestane tablets

Patient information

The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.

An excess amount of fluid around the cells, tissues or serous cavities of the body, leading to swelling.

Late (onset weeks to months)

Arthralgia and myalgia

Generalised joint pain or and/or stiffness and muscle aches, often worse upon waking or after long periods of inactivity. Can improve with movement. May be mild or severe, intermittent or constant and accompanied by inflammation.

The evidence supporting this protocol is provided by a phase III, multicentre, international, randomised trial (IES) involving 4724 patients comparing exemestane after two to three years of tamoxifen therapy with continuing tamoxifen therapy in postmenopausal women with primary breast cancer.r

Between 1998 and 2003, 2352 patients were randomised to receive exemestane 25 mg daily and 2372 patients were randomised to receive tamoxifen 20 mg (or 30 mg in Denmark) daily to complete a total of five years of adjuvant endocrine treatment.r

The primary end point was disease-free survival (DFS) and secondary end points were overall survival (OS), the incidence of contralateral breast cancer, and long-term tolerability.r

Efficacy

After a median follow-up of 55.7 months, in the intention to treat group, the unadjusted hazard ratio (HR) for DFS was 0.76 (95% CI 0.66 to 0.88; p = 0.0001) in favour of exemestane. This translated into a 3.3 % (95% CI 1.6 to 4.9) absolute improvement in DFS at 2.5 years after randomisation and a 3.4% (95% CI 0.1 to 6.8) improvement 5 years after randomisation.

Toxicity

Patients who received exemestane reported fewer venous thromboembolic events on treatment than did those on tamoxifen. The incidence of cardiovascular events (excluding venous thromboembolic events) did not seem to differ between the groups. Musculoskeletal pain, carpel tunnel syndrome, joint stiffness, paraesthesia, and arthralgia were reported more frequently and cramp less frequently in patients who switched to exemestane than those who remained on tamoxifen. Rates of fracture per 1000 women-years were 19.2 (99% CI 15.9 to 23.1) for exemestane and 15.1 (95% CI 12.2 to 18.7) for tamoxifen.

Fewer clinically serious gynaecological events were reported in patients who switched to exemestane but the number of endometrial cancers did not differ significantly.

Flinders Filters has partnered with eviQ to build reliable, robust search filters to retrieve core high level evidence on topics of significance to eviQ. The project goal is the provision of a sustainable model for evidence retrieval to ensure ongoing currency of content.

These search filters have been developed to retrieve the most up to date evidence from PubMed, in real time, using specifically designed search filters built to meet our needs.

Searches can be used when a protocol is scheduled for review or at any time you choose. Please click on the Specific, Balanced and Sensitive tabs below to access the Pubmed searches.

restricted to retrieving randomised control trials and systematic reviews.

is the middle ground between sensitive and specific searches.

retrieves all clinically relevant evidence - generally a broader search on a given topic.

Troubleshooting

Occasionally the searches may not display correctly or take too long to load (and will eventually timeout). This may be caused by Internet Explorer being unable to handle long URL's. You can rectify this by using Firefox, Safari or Google chrome. It is always a good idea to clear the cache regularly to ensure you are getting the most up to date search.

Feedback

If you identify any new articles that you believe should be included in the content, please use the feedback button below to inform us of the name of the article(s). This will generate an email to eviQ when feedback is entered; these comments will then be reviewed and made available to all users to view if appropriate.

Protocol reviewed by committee via email survey. No changes and next review in 2 years.

22/06/2015

Protocol reviewed electronically by Medical Oncology Reference committee. No changes and next review in 2 years.

18/02/2016

Discussion with Medical Oncology Reference Committee Chairs and protocol to be reviewed every 5 years. Next review due in 4 years.

31/05/2017

Transferred to new eviQ website. Version number change to V.3.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au